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Are doctors assessing patients with hypertension appropriately at their initial presentation?
Siew Lee Stalia Wong1, Ping Yein Lee2, Chirk Jenn Ng3
1University of Malaya Primary Care Research Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Insights
Primary care doctors poorly assessed cardiovascular disease (CVD) risk factors in newly diagnosed hypertension patients. Over 15 years, clinical examination documentation decreased, while investigations increased, indicating over-reliance on tests.
Area of Science:
- Cardiology
- Primary Care Medicine
- Public Health
Background:
- Hypertension is a major risk factor for cardiovascular disease (CVD).
- Early assessment of CVD risk factors and target organ damage (TOD) is crucial for effective hypertension management.
- Primary care physicians play a vital role in initial hypertension diagnosis and risk assessment.
Purpose of the Study:
- To evaluate the extent of cardiovascular disease (CVD) risk factor assessment in newly diagnosed hypertension patients during their first primary care visit.
- To analyze the 15-year trend in CVD risk factor assessment for hypertension patients.
Main Methods:
- Retrospective study analyzing 1,060 paper-based medical records of hypertension patients.
- Systematic random sampling (1:4) to extract data on CVD risk factors, target organ damage (TOD), and diagnostic procedures.
- Data collected from the patients' first hypertension clinic visit.
Main Results:
- Assessment of CVD risk factors during the first hypertension visit was suboptimal, ranging from 5.4% to 40.8%.
- Documentation of TOD history (5.8%-11.8%) and related physical examinations/investigations (0.1%-63.3%) was limited.
- A declining trend in documented physical examinations contrasted with an increasing trend in ordered investigations over the study period.
Conclusions:
- Primary care physicians demonstrated inadequate assessment of CVD risk factors, secondary hypertension causes, and TOD during initial hypertension consultations.
- Observed trends suggest a shift towards prioritizing investigations over comprehensive clinical examinations in hypertension management.
Introduction:
The aim of this study was to determine the extent to which primary care doctors assessed patients newly diagnosed with hypertension for the risk factors of cardiovascular disease (CVD) during the patients' first clinic visit for hypertension. The study also aimed to examine the trend of assessment for CVD risk factors over a 15-year period.
Methods:
This retrospective study was conducted between January and May 2012. Data was extracted from the paper-based medical records of patients with hypertension using a 1:4 systematic random sampling method. Data collected included CVD risk factors and a history of target organ damage (TOD), which were identified during the patient's first visit to the primary care doctor for hypertension, as well as the results of the physical examinations and investigations performed during the same visit.
Results:
A total of 1,060 medical records were reviewed. We found that assessment of CVD risk factors during the first clinic visit for hypertension was poor (5.4%-40.8%). Assessments for a history of TOD were found in only 5.8%-11.8% of the records, and documented physical examinations and investigations for the assessment of TOD and secondary hypertension ranged from 0.1%-63.3%. Over time, there was a decreasing trend in the percentage of documented physical examinations performed, but an increasing trend in the percentage of investigations ordered.
Conclusion:
There was poor assessment of the patients' CVD risk factors, secondary causes of hypertension and TOD at their first clinic visit for hypertension. The trends observed in the assessment suggest an over-reliance on investigations over clinical examinations.
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